半身麻醉不會增加術後下背痛的風險

Neuroaxial Anesthesia does not Increase the Risk of Postoperative Low Back Pain after Herniorrhaphy

背景及目的：半身麻醉後發生下背痛是臨床上常見的問題。但是半身麻醉是否會引起術後下背痛則是尚待釐清的議題。本研究的目的是利用全民健保資料庫來分析，進行疝氣修補術的成年病人中，接受半身麻醉是否會增加術後發生下背痛的風險。研究設計：本研究採用1998-2006年，全民健保資料庫100萬人隨機抽樣歸人檔，篩選出接受疝氣修補術的成年病患，再依照其麻醉方式分為半身麻醉和非半身麻醉兩組病人，術後追蹤一年，比較追蹤期間內因慢性下背痛就醫的比率是否有差異，並比較可能的影響因子。實驗結果：從全民健保資料庫中，共篩選出5,457位接受疝氣修補手術的成年病人，其中接受半身麻醉的成年病患有4,455人，接受非半身麻醉的病人有1,002位。追蹤術後一年發現，半身麻醉並未增加病人手術後發生急性下背痛（Odds Ratio=0.943, 95% CI, 0.647-1.374）與慢性下背痛（OR=0.937, 95% CI, 0.729-1.203）的風險。另外我們發現手術前一年內曾發生過下背痛的病患，術後發生下背痛的風險較高（P<0.00010）。研究結論：本研究顯示，成年病患接受疝氣修補手術，半身麻醉並不會增加術後下背痛的發生風險；有下背痛病史的病人，術後發生下背痛的風險較高。

Background: Backache is a common complaint after spinal or epidural anesthesia. The causal relationship between anesthesia and postoperative low back pain is still debated. The aim of this investigation is to explore the association between neuroaxial anesthesia and post-operative low back pain in adult patients receiving herniorrhaphy by analyzing the National Health Insurance Research Database (NHIRD). Methods: The study is a retrospective cohort study. We analyzed the Longitudinal Health Insurance Database (LHID) which contains all the original claim data of 1,000,000 beneficiaries randomly sampled from all beneficiaries of Taiwan's NHIRD over the period 1998 to 2006. We screened all adult patients (older than 18 year old) who received epidural anesthesia or spinal anesthesia for inguinal herniorrhaphy or femoral herniorrhaphy as the study cohort. These patients were followed up to 1 year after surgery by the diagnosis of low back pain (defined by ICD-9-CM codes 720 to 724, exclude cervical and thoracic region). The comparison cohort was adult patients who received non-neuroaxial anesthesia for herniorrhaphy. Results: Total 5,457 adult patients received herniorrhaphy were screened from NHIRD, in which 4,455 patients received neuroaxial anesthesia and the other 1,002 patients didn t. During the one-year follow-up period, 161 (3.61%) of the neuroaxial anesthesia group and 37 (3.69%) of the control group developed acute low back pain. 387(8.69%) of the neuroaxial anesthesia group and 89(8.88%) of the control group developed chronic low back pain. The patients received neuroaxial anesthesia didn t increase their risk in developing postoperative acute (OR=0.943, 95% CI, 0.647-1.374) and chronic low back pain (OR=0.937, 95% CI, 0.729-1.203). Conclusions: To our knowledge, this is the first nationwide population-based study regarding the association of post-herniorrhaphy backache with neuroaxial anesthesia in Taiwan. Our data showed that neuroaxial anesthesia does not increase the risk of low back pain in adult patients after herniorrhaphy. History of low back pain increased the risk of developing low back pain after surgery.